Diagnóstico de la tuberculosis latente en la era de la terapia biológica

  • María Carolina Ruiz
  • Zully González
  • Sol Beatriz Jiménez
  • Margarita Velásquez
Palabras clave: psoriasis, tuberculosis latente, adalimumab, etanercept, infliximab, TNFα, IL-12/IL-23, terapia biológica, tuberculina, pruebas IGRA

Resumen

La psoriasis es una de las enfermedades más frecuentes de la piel, caracterizada por placas eritematosas y descamativas, hasta el 30% de los pacientes pueden desarrollar artropatía psoriásica. Es una enfermedad inflamatoria, autoinmune mediada por citocinas Th1 y Th17. Se han empleado diversos tratamientos para el manejo de la enfermedad, la terapia biológica anti-TNFα ha demostrado ser útil en el control de la enfermedad cutánea y en modificar el curso de la artropatía psoriásica, de tal forma que su uso ha sido cada vez más difundido. Sin embargo, uno de los principales riesgos del bloqueo del TNFα es la reactivación de la tuberculosis latente. La reactivación de la tuberculosis también está asociada a la terapia biológica anti-IL-12/IL-23, efectiva en el control de la psoriasis. En esta revisión se presentan los aspectos más importantes de la psoriasis y la artropatía psoriásica y del diagnóstico de la tuberculosis latente.

Biografía del autor/a

María Carolina Ruiz

Médica, residente de Dermatología, Universidad CES, Medellín, Colombia

Zully González

Médica dermatóloga, profesora de Dermatología, Universidad de Antioquia, Medellín, Colombia

Sol Beatriz Jiménez

Médica dermatóloga, profesora de Dermatología, Universidad CES, Medellín, Colombia

Margarita Velásquez

Medica Dermatologa, DrSc en Inmunología, profesora, Sección de Dermatología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia. Grupo de Investigación Dermatológica, GRID

Referencias bibliográficas

1. Kang A, Won Lee H, Yoon H, Cho B, Koo Han S, Shim. Discrepancy between the TST and the IGRA for the diagnosis of LTB infection in an intermediate tuberculosis-burden country young. JAMA. 2005;293:2756-61.
2. Felipe OJ, Ruiz O, Valle R. Tuberculosis y tratamiento anti TNF. Revista Colombiana de Reumatología 2004;11:306-16.
3. Tsiouri G, Gaitanis G, Kiorpelidou D, Dionysiou A, Efthymiou A, Daskalopoulos G, et al. Tuberculin skin test overestimates tuberculosis hypersensitivity in adult patients with psoriasis. Dermatology. 2009;219:119-25.
4. Beglinger C, Dudler J, Mottet C, Nicod L, Seibold F, Villiger P, et al. Screening for tuberculosis before anti-TNF treatment. Swiss Med Wkly. 2007;137:621-22.
5. Desai N, Raste Y, Cooke NT, Harland CC. QuantiFERON TB gold testing for tuberculosis in psoriasis patients commencing anti-tumour necrosis factor a therapy. Br J Dermatol. 2008;159:992-3
6. Candia L, Marquez J, Gonzalez C, Santos AM, Londoño J, Valle R, Zabaleta J, Yaqub Z, Espinoza LR. Low frequency of anticyclic citrullinated peptide antibodies in psoriatic arthritis but not in cutaneous psoriasis. J Clin Rheumatol. 2006;12:226-9.
7. Jackson M. TNF-α inhibitors. Dermatol Ther. 2007;20:251-64.
8. Ehlers S. Why does tumor necrosis factor targeted therapy reactivate tuberculosis? J Rheumatol. 2005;32:35-9.
9. Gardam M, Keystone E, Menzies R, Manners S, Skamene E, Long R, et al. Antitumour necrosis factor agents and tuberculosis risk: mechanisms of action and clinical management. Lancet Infect Dis. 2003;3:148-55.
10. Krueger JG, Bowcock A. Psoriasis pathophysiology: current concepts of pathogenesis. Ann Rheum Dis. 2005;64(Suppl.2):30-6.
11. Sabat R, Philipp S, Höflich C, Kreutzer S, Wallace E, Asadullah K, et al. Immunopathogenesis of psoriasis. Exp Dermatol. 2007;16:779-98.
12. Lowes MA, Bowcock AM, Krueger JG. Pathogenesis and therapy of psoriasis. Nature. 2007;445:866-73.
13. Nestle FO, Nickoloff BJ. Role of dendritic cells in benign and malignant lymphocytic infiltrates of the skin. Dermatol Clin. 1994;12:271-82.
14. Gaspari AA. Innate and adaptive immunity and the pathophysiology of psoriasis. J Am Acad Dermatol. 2006;54(Suppl.2):S67-S80.
15. Menssen A, Trommler P, Vollmer S, Schendel D, Albert E, Gürtler L, et al. Evidence for an antigen-specific cellular immune response in skin lesions of patients with psoriasis vulgaris. J Immunol. 1995;155:4078-83.
16. Bowcock AM, Krueger JG. Getting under the skin: the immunogenetics of psoriasis. Nature Rev Immunol. 2005;5:699-711.
17. Zippin JH. The genetics of psoriasis. J Drugs Dermatol. 2009;8:414-7.
18. Krüger-Krasagakis S, Galanopoulos VK, Giannikaki L, Stefanidou M, Tosca AD. Programmed cell death of keratinocytes in infliximab-treated plaque-type psoriasis. Br J Dermatol. 2006;154:460-6.
19. Veale DJ, Ritchlin C, Fitzgerald O. Immunopathology of psoriasis and psoriatic arthritis. Ann Rheum Dis. 2005;64(Suppl.2):26-9.
20. Tzu J, Kerdel F. From conventional to cutting edge: the new era of biologics in treatment of psoriasis. Dermatol Ther. 2008;21:131-41.
21. Zaba LC, Suárez-Fariñas M, Fuentes-Duculan J, Nograles KE, Guttman-Yassky E, Cardinale I, Lowes MA, Krueger JG. Effective treatment of psoriasis with etanercept is linked to suppression of IL-17 signaling, not immediate response TNF genes. J Allergy Clin Immunol. 2009;124:1022-10.
22. Fitch E, Harper E, Skorcheva H, Kurtz S, Blauvelt A. Pathophysiology of psoriasis: recent advances on IL-23 and Th17 cytokines. Curr Rheumatol Rep. 2007;9:461-7.
23. Di Cesare A, Di Meglio P, Nestle FO. The IL-23/Th17 axis in the immunopathogenesis of psoriasis. J Invest Dermatol. 2009;129:1339-50.
24. Krueger GG, Langley RG, Leonardi C, Yeilding N, Guzzo C, Wang Y, Dooley LT, et al. A human interleukin-12/23 monoclonal antibody for the treatment of psoriasis. N Engl J Med. 2007;356:580-92.
25. Griffiths CE, Strober BE, van de Kerkhof P, Ho V, FidelusGort R, et al. Comparison of ustekinumab and etanercept for moderate-to-severe psoriasis. N Engl J Med. 2010;362:118- 28.
26. Mease PJ. Tumour necrosis factor (TNF) in psoriatic arthritis: pathophysiology and treatment with TNF inhibitors. Ann Rheum Dis. 2002;61:298-304.
27. Mease PJ. Cytokine blockers in psoriatic arthritis Ann Rheum Dis. 2001;60:37-40.
28. Young M, Furfaro N, Rai A. Diagnosis and management of psoriatic arthritis. Journal of the Dermatology Nurses’ Association. 2008;1:283-93.
29. Gladman DD. Psoriatic arthritis. Dermatol Ther. 2009;22:40-55.
30. Wallis R. Reactivation of latent tuberculosis by TNF blockade: the role of interferon c. J Investig Dermatol Symp Proc. 2007;12:16-21.
31. Ustekinumab for the treatment of adults with moderate to severe psoriasis. National Institute for Health and Clinical Excellence (NICE) technology appraisal guidance 180 (TA180). London, United Kingdom: National Institute for Health and Clinical Excellence; 2009.
32. Stelara, official FDA information; 2009. Consultado diciembre 2009: Disponible en: www.drugs.com.
33. Richeldi L. An update on the diagnosis of tuberculosis infection. Am J Respir Crit Care Med. 2006;174:736-42.
34. Escalante P. In the clinic: tuberculosis. Ann Intern Med. 2009;150:61-4.
35. Gómez-Reino JJ, Carmona L, Valverde VR, Mola EM, Montero MD; BIOBADASER Group. Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to significant increase in tuberculosis risk: a multicenter active-surveillance report. Arthritis Rheum. 2003;48:2122-7.
36. Lalvani A, Millington KA. Screening for tuberculosis infection prior to initiation of anti-TNF therapy. Autoimmunity Rev. 2008;8:147-52.
37. Ministerio de la Protección Social. Guías de promoción de la salud y prevención de enfermedades en la salud pública. Guía de la atención de la tuberculosis pulmonar y extrapulmonar. Programa de Apoyo a la Reforma de Salud/PARS. Bogotá: Ministerio de la Protección Social; actualización septiembre 2009.
38. Gottlieb A, Korman NJ, Gordon KB, Feldman SR, Lebwohl M, Koo JY, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008;58:851-64.
39. British Thoracic Society Standards of Care Committee. BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNFα treatment. Thorax. 2005;60:800-5.
40. Department of Health and Human Services, Centers for Disease Control and Prevention National Center for HIV, STD, and TB Prevention. Targeted tuberculin testing and treatment for latent tuberculosis. Atlanta: CDC, Division of Tuberculosis Elimination; 2005
41. Mariette X, Salmon D, Group RATIO. French guidelines for diagnosis and treating latent and active tuberculosis in patients with RA treated with TNF blockers. Ann Rheum Dis. 2003;62;791.
42. Department of Health and Human Services, Centers for Disease Control and Prevention National Center for HIV, STD, and TB. Targeted tuberculin testing and treatment for latent tuberculosis prevention. Atlanta: CDC, Division of Tuberculosis Elimination; 2000.
43. Interferon-assays for tuberculosis anergy. Am J Respir Crit Care Med. 2005;172:519-21.
44. Updated recommendations on interferon gamma release assays for latent tuberculosis infection. An Advisory Committee Statement (ACS). Can Commun Dis Rep. 2008;34(ACS-6):1-13.
45. Mori T, Sakatani M, Yamagishi F, Takashima T, Kawabe Y, Nagao K, et al. Specific detection of tuberculosis infection. Am J Respir Crit Care Med. 2004;170:59-64.
46. Madariaga MG, Jalali Z, Swindells S. Clinical utility of interferon gamma assay in the diagnosis of tuberculosis. J Am Board Fam Med. 2007;20:540-7.
47. Menzies D, Pai M, Comstock G. Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med. 2007;146:340-54.
48. Zhao X, Mazlagic D, Flynn EA, Hernandez H, Abbott CL. Is the QuantiFERON-TB blood assay a good replacement for the tuberculin skin test in tuberculosis screening? A pilot study at Berkshire Medical Center. Am J Clin Pathol. 2009;132:678-86.
49. Ponce de Leon D, Acevedo-Vasquez E, Alvizuri S, Gutierrez C, Cucho M, Alfaro J, Perich R, Sanchez-Torres A, Pastor C, Sanchez-Schwartz C, Medina M, Gamboa R, Ugarte M. Comparison of an interferon-gamma assay with tuberculin skin testing for detection of tuberculosis (TB) infection in patients with rheumatoid arthritis in a TB-endemic population. J Rheumatol. 2008;35:776-81.
50. Soborg B, Ruhwald M, Hetland ML, Jacobsen S, Andersen AB, Milman N, Thomsen VO, Jensen DV, Koch A, Wohlfahrt J, Ravn P. Comparison of screening procedures for Mycobacterium tuberculosis infection among patients with inflammatory diseases. J Rheumatol. 2009;36:1876-84.
51. Laffitte E, Janssens JP, Roux-Lombard P, Thielen AM, Barde C, Marazza G, Panizzon RG, Saurat JH. Tuberculosis screening in patients with psoriasis before antitumour necrosis factor therapy: comparison of an interferon-gamma release assay vs. tuberculin skin test. Br J Dermatol. 2009;161:797-800.
52. Theis V, Rhodes J. Minimizing tuberculosis during anti-TNF treatment of IBS. Aliment Pharmacol Ther. 2008;27:19-30.
53. Primer Consenso Latinoamericano de Psoriasis. Rio de Janeiro, Brasil, 2009. Consultado diciembre 2009: Disponible en: www. solapso.org/archivos/LATINOAMERICANO-1_2009.pdf
Cómo citar
1.
Ruiz MC, González Z, Jiménez SB, Velásquez M. Diagnóstico de la tuberculosis latente en la era de la terapia biológica. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 26 de febrero de 2019 [citado 4 de octubre de 2022];18(3):139-48. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/325

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Publicado
2019-02-26
Sección
Artículo de revisión

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